1. Field of the Invention
The present invention is a method of treating topical application of known pharmaceutically useful Oxazolidinone antibacterials to treat non-topical infections.
2. Description of the Related Art
U.S. Pat. Nos. 5,164,510, 5,231,188, 5,565,571, 5,652,238, 5,688,792, 5,698,574 and 5,627,181 all disclose various oxazolidinone antibiotics which are well known to those skilled in the art.
U.S. Pat. No. 5,688,792 discloses various oxazolidinone antibiotics which can be administered orally, parenterally or topically. The topical application being by gel or cream vehicle.
PCT patent application PCT/US97/07124 published as International Publication WO97/42954 discloses a method of transdermal administration of a number of antimicrobial agents for treating or preventing systemic bacterial diseases which comprised use of DMSO/water carrier which comprised at least 10% DMSO. None of the antimicrobial agents of International Publication WO97/42954 included Oxazolidinones and the present invention does not use any DMSO.
U.S. Pat. No. 3,743,727 discloses a method of enhancing the penetration into and across the external membrane barrier of an animal subject of an antimicrobial agent of various types which comprised sufficient DMSO to sufficiently enhance the penetration of the antimicrobial agent. None of the antimicrobial agents included oxazolidinones and the present invention does not use any DMSO.
PCT patent application PCT/US84/00899 published as International Publication WO85/00108 discloses a method of treating acne with topical preparations comprising an antibacterial agent in DMSO. None of the antibacterial agents included oxazolidinones and the present invention does not use any DMSO.
U.S. Pat. No. 4,943,435 discloses a transdermal patch for controlled delivery of nicotine. This is a small molecule and not an antibacterial agent.
Disclosed is a method of treating a non-topical infection selected from the group consisting of ear infections, skin and soft tissue infections, acne, infected wounds, bacteremia, in a useful warm blooded mammal who is in need of such treatment which comprises topical administration of a pharmaceutical formulation containing a transdermally effective amount of an Oxazolidinone.
U.S. Pat. No. 5,688,792 which disclosed various oxazolidinone antibiotics disclosed they could be administered orally, parenterally or topically. Topical administration is not specifically defined but used in its ordinary meaning. Dorland""s Illustrated Medical Dictionary (twenty-sixth edition, 1981, page 1377) defines topical as, xe2x80x9cpertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied.xe2x80x9d Therefore, topical administration is administration to a certain area of the skin where the applied item only affects the area to which it is applied. This differs significantly from transdermal. Topical differs from transdermal in that transdermal administration refers to topical administration of an agent, for the purpose of delivering the agent to an adjacent, underlying or distant site or tissue which is different than the site of application. With the Oxazolidinones of the present invention, it is understood that the topical application is to the top of the skin which is not the site of antibacterial activity, which is below or away from the site of topical application. The Oxazolidinone may have antibacterial activity at the top of the skin where [applied] it is applied but that is incidental to the site of intended action. The infection being treated is a non-topical infection.
The claimed invention is a method of treating an infection selected from the group consisting of ear infections, skin and soft tissue infections, acne, infected wounds, bacteremia, in a useful warm blooded mammal who is in need of such treatment which comprises topical administration of a transdermally effective amount of an Oxazolidinone.
Useful warm blooded mammals which are within the scope of the present invention include humans, pets such as dogs, cats and commercially important mammals such as horses, cattle, pigs. It is preferred that the mammal be a human, dog or cat; more preferably a human.
The Oxazolidinones of the present invention are known, see EXAMPLES 1 thru 6 (Oxazolidinones). It is preferred that the Oxazolidinone be selected from the group consisting of:
(S)-N-[[3-[3-fluoro-4-[4-(hydroxyacetyl)-1-piperazinyl]-phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide,
(S)-N-[[3-[3-fluoro-4-(4-morpholinyl)phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide,
[4(S)-cis]-(xe2x88x92)-N-[[3-[3-fluoro-4-(tetrahydro-1-oxido-2H-thiopyran-4-yl)phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide,
N-((5S)-3-(3-fluoro-4-(4-(2-fluoroethyl)-3-oxopiperazin-1-yl)phenyl)-2-oxooxazolidin-5-ylmethyl)acetamide,
(S)-N-[[3-[5-(3-pyridyl)thiophen-2-yl]-2-oxo-5-oxazolidinyl]methyl]acetamide and
(S)-N-[[3-[5-(4-pyridyl)pyrid-2-yl]-2-oxo-5-oxazolidinyl]methyl]acetamide hydrochloride. It is more preferred that the Oxazolidinone be selected from the group consisting of:
(S)-N-[[3-[3-fluoro-4-[4-(hydroxyacetyl)-1-piperazinyl]-phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide,
(S)-N-[[3-[3-fluoro-4-(4-morpholinyl)phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide and
[4(S)-cis]-(xe2x88x92)-N-[[3-[3-fluoro-4-(tetrahydro-1-oxido-2H-thiopyran-4-yl)phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide; and it is even more preferred that the Oxazolidinone be (S)-N-[[3-[3-fluoro-4-(4-morpholinyl)phenyl]-2-oxo-5-oxazolidinyl]methyl]acetamide.
The infections treated by the present invention include ear infections, skin and soft tissue infections, acne, infected wounds and bacteremia which are not topical infections but rather infections of the underlying tissue.
Ear infections can be caused by either gram positive or gram negative bacteria or mixture of both. About 60% of the time, the ear infection is caused by gram positive bacteria and in those cases the method of the present invention will be useful in treating the ear infection. If not treated successfully, the two important consequences are the ear drum can rupture leading to a reduction in hearing, and the surrounding tissues including bone can become infected and lead to a more life threatening condition. Ear infections are most often caused by Streptococcus pneumoniae and sometimes by Streptococcus pneumoniae and Haemophilus influenzae at the same time. It is apparent to one skilled in the art that a subject is in need of treatment for an ear infection when there is a fever and the patient has pain in the ear or the patient has pain in the ear and an ear exam discloses a swollen ear rum and fluid is observed behind the ear drum. Ear infections are treated by administering the desired Oxazolidinone(s) directly to the affected ear by use of a pharmaceutical formulation which is a solution, suspension or emulsion. It is preferred that the transdermally effective amount of the Oxazolidinone for treatment of ear infections is from about 0.1 to about 10%; it is more preferred that the transdermally effective amount is from about 0.2 to about 2%. The Oxazolidinone should be administered two thru four times daily for 3 to 14 days. It is preferable if 0.25 to 1 ml of the pharmaceutical formulation is containing the Oxazolidinone is administered each time it is administered.
Skin and soft tissue infections are infections which are most often caused by staphylococci and streptococci. Such infections are very difficult to treat with known antibiotics because of their location and treatment failures occur often requiring additional courses of therapy. These infections include skin (cellulitis and superficial infections) and skin-associated soft tissue infections (subcutaneous tissue infections and abscesses as well as myostis) where the (gram positive) bacteria are present in the epidermis, dermis, fat layer and/or muscle layers underlying the epidermis. It is apparent to one skilled in the art that a subject is in need of treatment for a soft tissue and/or skin infection when the subject has an inflamed, reddened, or tender area of the body which is coupled with a fever. The skin and soft tissue infections are treated by administering the desired Oxazolidinone(s) directly to a site such that the affected area is adjacent, underlying or distant from the site of application by use of the appropriate pharmaceutical dosage form. It is preferred that the Oxazolidinone be administered in the form of a pharmaceutical formulation which is a cream, ointment, gel and emulsion and it is preferred that the pharmaceutical formulation be applied or administered two thru four times daily, preferably two or three times daily until 24 after the fever is at normal and the redness, swelling and inflammation are gone. It is preferred that the transdermally effective amount to treat skin and soft tissue infections be from about 0.2 to about 40%; more preferably from about 0.4 to about 10%. Other sanitary precautions should be utilized as are known to those skilled in the art.
Acne refers to acne serious enough to be treated by a physician, termed acne vulgaris. Acne vulgaris is caused by the anaerobic bacterium Propionibacterium acnes which is found in blocked and inflamed oil glands or ducts in the skin of humans, particularly teenagers. These infections occur well below the surface of the skin and need to be treated at that area. While not life threatening, serious acne can cause both skin scars and emotional trauma. It is preferred that the acne be treated with a pharmaceutical formulation which is a cream, ointment, gel, emulsion, suspension, solution and patch. The transdermal effective amount of the Oxazolidinone is preferably from about 0.1 to about 10%; more preferably from about 0.2 to about 6%. The acne is treated two thru four times daily until the acne is contained to the satisfaction of the patient and treating physician.
Wounds refer to and include wounds caused by natural causes such as accidents and intentional wounds such as those caused by surgery. Because of the opening into the body, as in a penetrating wound, gram positive microorganism often are able to get in and cause an infection. These infections can be very serious and even life threatening. Because the Staphaphlococcus organisms are on our skin, once a wound occurs, regardless of the cause, these microorganisms enter the body thru the wound. By definition the wound is not just on the surface, but includes the underlying infected area below the skin. The wound is treated two thru four times daily until the infection is gone.
Bacteremia is an infection where bacteria are present in the blood and can be microbiologically cultured from blood samples. Bacteremia is caused by the gram positive organisms identified in this patent are preferably treated with pharmaceutical compositions of Oxazolidinone including cream, ointment, gel, emulsion and suspension. It is preferred that the transdermal effective amount is from about 1 to about 40%; it is more preferred that the transdermal effective amount is from about 5 to about 20%. The bacteremia infection is treated twice to four times daily until the infection is gone.
The gram positive microorganisms which cause the infections treated by the Oxazolidinones of the present invention include Staphylococci, Streptococci and Enterococci. It is preferred that the infection be caused by Staphyloccoci. The important species of these genius are Staphloccus aureus, Staphloccus epidermidis and Staphyloccus hemolyticus. The Oxazolidinones of the present invention also treat gram negative infections caused by anaerobes such as Bacteroides fragilis. 
By xe2x80x9ctreating an infectionxe2x80x9d selected from the group consisting of ear infections, skin and soft tissue infections, acne, infected wounds and bacteremia in a useful warm blooded mammals who is in need of such treatment, means the mammal has an infection which is causing it a problem, whether a fever, pain such as ear ache, abscess, infection and inflammation of a tissue or a wound. Treating the infection means administering to the mammal an Oxazolidinone such that the mammal obtains sufficient concentration of the Oxazolidinone in the affected area to either kill the existing microorganisms and/or to reduce their rate of multiplication (increase) to a point where the body""s natural defense mechanism can reduce the unwanted microorganisms to a level which does not cause clinical problems. xe2x80x9cTreatingxe2x80x9d also includes preventing an infection, or preventing a minor infection to grow into a larger one especially with acne. Even though the patient may not observe blocked or inflamed oil glands or ducts, they may still be present but at a greatly reduced stage. Treating a teenager who has had acne to prevent future occurrence is included within the scope of xe2x80x9ctreatingxe2x80x9d as used in this patent.
In the method of the present invention, the Oxazolidinones can be used either individually or in combination with each other. Further, they can be used in combination with other antibacterial agents which are being administered by oral administration. In addition, the Oxazolidinones can be used with non-antibacterial agents in treating the infections of this invention.
The exact dosage and frequency of administration depends on the particular Oxazolidinone used, the particular condition being treated, the severity of the condition being treated, the age, weight, general physical condition of the particular patient, other, medication the individual may be taking as is well known to those skilled in the art and can be more accurately determined by measuring the blood level or concentration of the Oxazolidinone in the patient""s blood and/or the patient""s response to the particular condition being treated.
The definitions and explanations below are for the terms as used throughout this entire document including both the specification and the claims.
All temperatures are in degrees Centigrade.
THF refers to tetrahydrofuran.
DMF refers to dimethylformamide.
Saline refers to an aqueous saturated sodium chloride solution.
Chromatography (column and flash chromatography) refers to purification/separation of compounds expressed as (support, eluent). It is understood that the appropriate fractions are pooled and concentrated to give the desired compound(s).
Ether refers to diethyl ether.
TLC refers to thin-layer chromatography.
When solvent pairs are used, the ratios of solvents used are volume/volume (v/v).
When the solubility of a solid in a solvent is used the ratio of the solid to the solvent is weight/volume (wt/v).
Pharmaceutically acceptable refers to those properties and/or substances which are acceptable to the patient from a pharmacological/toxicological point of view and to the manufacturing pharmaceutical chemist from a physical/chemical point of view regarding composition, formulation, stability, patient acceptance and bioavailability.